2020
DOI: 10.1182/hematology.2020000137
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Platelet transfusion refractoriness: how do I diagnose and manage?

Abstract: Platelet refractoriness continues to be a problem for thrombocytopenic patients because the risk of a major spontaneous or life-threatening bleed significantly increases when platelet counts drop below 10 × 109/L. The majority of patients have nonimmune causes driving the refractoriness, such as bleeding, medications, or diffuse intravascular coagulation; however, this article is dedicated to the diagnosis and support of patients with immune-based platelet refractoriness. Antibodies to class I HLA molecules (A… Show more

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Cited by 62 publications
(52 citation statements)
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“…Platelet and fresh frozen plasma (FFP) transfusions were administered for this patient as a result of active bleeding and severely low platelet count and prolonged aPTT [ 14 ]. However platelet transfusions have not resulted in improvement of platelet count in this case, which also might be due to antiplatelet antibodies on the surface of transfused platelets [ 15 ].…”
Section: Discussionmentioning
confidence: 99%
“…Platelet and fresh frozen plasma (FFP) transfusions were administered for this patient as a result of active bleeding and severely low platelet count and prolonged aPTT [ 14 ]. However platelet transfusions have not resulted in improvement of platelet count in this case, which also might be due to antiplatelet antibodies on the surface of transfused platelets [ 15 ].…”
Section: Discussionmentioning
confidence: 99%
“…Immunotherapy failure is defined as the failure to respond to the best available immunosuppressive treatment lasting for 6 months, including CSA therapy or combined ATG and CSA therapy ( Deeg et al, 2006 ). Platelet refractoriness is defined as lower-than-expected post-transfusion count increments after repeated platelet transfusions ( Cohn, 2022 ). The donor type included MSD, URD and HID, the latter two of which describe alternative donors.…”
Section: Methodsmentioning
confidence: 99%
“…Sixty to 80% of the PLT transfusion refractoriness cases are not associated with immunological aspects, but present non-immune etiologies such as massive bleeding, fever, infection, sepsis, drugs, accelerated PLT consumption, splenic sequestration or graft-versus-host disease ( 2 , 3 ). Ten to 39% of the cases of PLT transfusion refractoriness are triggered by the development of antibodies specific for antigens expressed on the PLT surface or the development of drug-dependent PLT antibodies ( 3 , 4 ). Immune causes of PTR include the alloimmunization to the human leukocyte antigen (HLA) and or human PLT antigens (HPA) triggered by previous transfusions, pregnancies, transplantation or PLT autoantibodies.…”
Section: Platelet Transfusion Refractorinessmentioning
confidence: 99%